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J Reconstr Microsurg 2023; 39(09): 671-680
DOI: 10.1055/s-0043-1764486
Original Article

Evaluating Disparities in Pathways to Breast Reconstruction

Sabrina M. Wang 
1   Duke University School of Medicine, Durham, North Carolina
,
Moreen W. Njoroge
1   Duke University School of Medicine, Durham, North Carolina
,
Lily R. Mundy
2   Department of Orthopaedic Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland
3   Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
,
Amanda R. Sergesketter
4   Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, North Carolina
,
Bryanna Stukes
1   Duke University School of Medicine, Durham, North Carolina
,
Ronnie L. Shammas
4   Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, North Carolina
,
Hannah C. Langdell
4   Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, North Carolina
,
Yisong Geng
5   Calc LLC, Wilton, Connecticut
,
Scott T. Hollenbeck
4   Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, North Carolina
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Abstract

Background Rates of postmastectomy breast reconstruction have been shown to vary by racial, ethnic, and socioeconomic factors. In this study, we evaluated disparities across pathways toward breast reconstruction.

Methods All women who underwent mastectomy for breast cancer at a single institution from 2017 to 2018 were reviewed. Rates of discussions about reconstruction with breast surgeons, plastic surgery referrals, plastic surgery consultations, and ultimate decisions to pursue reconstruction were compared by race/ethnicity.

Results A total of 218 patients were included, with the racial/ethnic demographic of 56% white, 28% Black, 1% American Indian/Native Alaskan, 4% Asian, and 4% Hispanic/Latina. The overall incidence of postmastectomy breast reconstruction was 48%, which varied by race (white: 58% vs. Black: 34%; p < 0.001). Plastic surgery was discussed by the breast surgeon with 68% of patients, and referrals were made in 62% of patients. While older age (p < 0.001) and nonprivate insurance (p < 0.05) were associated with lower rates of plastic surgery discussion and referral, it did not vary by race/ethnicity. The need for an interpreter was associated with lower rates of discussion (p < 0.05). After multivariate adjustment, a lower reconstruction rate was associated with the Black race (odds ratio [OR] = 0.33; p = 0.014) and body mass index (BMI) ≥ 35 (OR = 0.14; p < 0.001). Elevated BMI did not disproportionately lower breast reconstruction rates in Black versus white women (p = 0.27).

Conclusion Despite statistically equivalent rates of plastic surgery discussions and referrals, black women had lower breast reconstruction rates versus white women. Lower rates of breast reconstruction in Black women likely represent an amalgamation of barriers to care; further exploration within our community is warranted to better understand the racial disparity observed.

Keywords

breast reconstruction - disparities - breast cancer

Supplementary Material



Publikationsverlauf

Eingereicht: 30. Juli 2022

Angenommen: 08. Januar 2023

Artikel online veröffentlicht:
06. April 2023

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